Kornimate/medical-research-clean huggingface dataset:
customized choice of oral p2y12 receptor blocker

Conditions: Acute Coronary Syndrome; Coronary Angioplasty

Summary: a subset of patients recruited in the main matrix study will be randomized after intervention but before discharge to standard of care (the treating physician will decide which oral p2y12 inhibitor will be added on top of aspirin) versus a customized approach based on an algorithm which integrates phenotypic information, including but not limited to residual on-treatment platelet reactivity assessed via verifynow p2y12 assay.

up to 20-30% of clopidogrel treated patients do not adequately respond to the drug and are at higher risk for ischemic events including death, myocardial infarction, stroke and stent thrombosis. residual high on-treatment platelet reactivity while the patient is on clopidogrel depends on a complex interplay of phenotypic (spontaneous platelet reactivity, inflammatory status, acuity of the clinical presentation, age, renal function) and genetic variables. two main loss of function alleles have been identified: 1) cyp450 2c19\*2 is present in around 25% of the caucasian population and result in a lower amount of clopidogrel active metabolite. carriers of 2c19\*2 are at higher risk for death or mi and 2.7 fold increase in the risk of stent thrombosis if treated with conventional clopidogrel; 2) abcb-1 c carriers have reduced clopidogrel absorption and they have similarly been shown to be at higher risk for ischemic adverse events if treated with clopidogrel. many investigators have recently shown however, that the positive predictive value of genetic testing alone at the time of pci is limited and the knowledge of genetic status alone with respect to the two previously described loss of function alleles is only poorly able to identify to long-term clopidogrel poor responders. an algorithm has therefore been developed, combining phenotype information which has been shown to risk stratify both ischemic and bleeding events up to one year follow-up in pci patients. this algorithm has been developed from a single center retrospective registry. to prospectively validate it in the context of a prospective multicenter study, the first 320 patients recruited in the present study will undergo phenotype at discharge and at 30 days and genotype assessment at the time of randomization, irrespective of the group which they have been assigned to (i.e. standard of care or gene and phenotype). the hypothesis behind this mechanistic sub-study is that the use of this combined phenotype-genotype algorithm will increase the proportion of patients at 30 days who will be in the therapeutic range according to pru values from 50% in the standard of care versus 70% in the gene and phenotype group.

Eligibility criteria:
inclusion criteria: * patients recruited in the main matrix study who underwent coronary angioplasty with stent placement. exclusion criteria: * unwillingness to sign this sub study specific informed consent

Keywords: myocardial infarction coronary stent oral p2y12 receptor blocker platelet reactivity units (pru)
sensor measurement of acupuncture needle manipulation

Conditions: Back Pain

Summary: the purpose of this study is to develop and test a sensor system capable of measuring acupuncture needle manipulation and torque in a clinical setting. study hypothesis: torque will be greater on the side of the back with musculoskeletal pain compared with the side without pain.

acupuncture is an ancient chinese practice that involves the use of specialized needles to stimulate parts of the body. the number of americans who use acupuncture services continues to grow each year. two elements required to deliver high-quality acupuncture treatment are identification of the appropriate acupuncture points and proper manipulation of the acupuncture needle. despite a growing awareness of the importance of proper needle techniques, no tool capable of objectively measuring needle manipulation in a clinical setting has ever been developed. such a tool would have applications in acupuncture research, teaching, and clinical practice. this study will develop and test a simple hand-held sensor capable of making such objective needle torque measurements. there are two parts to this study. in part 1, researchers will develop the hand-held sensor (called the acusensor) that will be mounted to the handle of an acupuncture needle and will measure torque during manual needle manipulation. in part 2, the sensor will be tested for accuracy and reliability in three different groups. group 1 will consist of patients with unilateral musculoskeletal back pain. group 1 participants will undergo one session of acupuncture treatment while torque measurement and needle manipulation techniques are examined. in group 2, practitioners and students at two leading acupuncture schools will use the acusensor during their teaching clinics. teachers and students will complete a questionnaire to evaluate the sensor's usefulness. experienced acupuncturists comprise group 3; they will receive acusensor training and evaluate the performance of the acusensor in clinical practice. information about the range and variability of torque measurements produced by different practitioners and techniques will be obtained from use of the sensor. group 3 acupuncturists will also guess needle torque before and after training with the sensor turned off in order to determine the way acusensor training affects acupuncturists' sensory perception of needle grasp.

Eligibility criteria:
inclusion criteria for group 1 participants: * asymmetric chronic musculoskeletal back pain

Keywords: acupuncture
effect of shock wave therapy on myofascial pain syndrome in adolescent athletes

Conditions: Myofascial Pain Syndrome

Summary: the purpose of the study is to determine the effect of extracorporeal shockwave therapy on pain, neck range of motion, and functional activity in adolescent athletes.

myofascial pain syndrome is a syndrome characterized by pain and accompanying muscle spasms, referred pain patterns, stiffness, and restricted range of motion caused by trigger points on constricted fibers of muscles and/or fasciae. myofascial pain syndrome is the most common reason for back pain, shoulder pain, tension-type headaches, and regional pains such as facial pain. myofascial trigger points (mtrps) are understood as the morphological correlate of the myofascial pain syndrome (mps), an acute or chronic muscular pain condition affecting a single muscle or a group of muscles. active mtrps are spontaneously painful, while latent mtrps are only painful upon pressure. mtrp stimulation can also cause referred pain and the characteristic local twitch response. the main goal of mps treatment is to break down the vicious circle of "spasm - pain - spasm" and release trigger points. various physical therapy modalities such as trigger point injection, stretching-spray technique or ultrasound (us), heat packs and transcutaneous electrical nerve stimulation (tens), and extracorporeal shock wave therapy (eswt), are used for the treatment of mps. these modalities inactivate the trigger point with their thermal and mechanical effects. due to the lack of research area of extracorporeal shock wave therapy on myofascial pain syndrome on upper trapezius in adolescents' athletes, so the purpose of the study is to know impact of the extracorporeal shock wave therapy on myofascial pain syndrome on upper trapezius in adolescents' athletes.

Eligibility criteria:
inclusion criteria: * age ranges from 14 to 18 years. * all adolescents have regional pain complaint. * tenderness in cervical trigger points in the midpoint of the upper border of the trapezius muscle, from grade 2 to grade 4 according to the tenderness grading scheme (hubbard, 1993) (appendix ii). * palpation of a trigger point elicits a stereotypic zone of referred pain specific to that muscle. * identification of a palpable taut band, as well as a palpable, and exquisitely tender spot along the length of that taut band. * all adolescents are allowed to practice their regular sports activities. exclusion criteria: * dermatological disorders. * having myofascial trigger points injection. * chronic pain in both sides of the body. * history of findings of cervical injury whether orthopedic or soft tissue injury. * analgesic drugs or nsaids during the treatment period.
effect of acupuncture on the gait disturbance and hemodynamic changes in the prefrontal cortex

Conditions: Alzheimer Disease

Summary: background: alzheimer's disease (ad) is characterized by cognitive impairment and behavioral impairment, and increasing attention is paid in the gait of ad patients. the aim of this randomized controlled trial (rct) is to explore the effect of acupuncture on the cognitive function, gait performance, and hemodynamic changes in the prefrontal cortices. methods: in this rct, a total of 108 ad patients will be randomly assigned into acupuncture group or control group for 8 weeks. the primary outcome will be three-dimensional gait analysis and cerebral hemodynamics using functional near-infrared spectroscopy (fnirs). secondary outcomes include mini-mental state examination (mmse), montreal cognitive assessment (moca), and barthel index (bi). discussion: this trial is expected to explore the effect of acupuncture on cognitive function, gait performance, and hemodynamic changes in the prefrontal cortices for ad patients.

this study aims to assess the clinical effect of acupuncture on gait performance in ad patients and to examine the acupuncture effect on cerebral cortices by identifying hemodynamic changes that occur in the prefrontal cortices using the fnirs technique.

Eligibility criteria:
the inclusion criteria are as follows: 1. aged 40-85 years old; 2. meeting the mentioned-above diagnostic criteria from traditional chinese medicine and western medicine; 3. with mild to moderate dementia (cdr=0.5, 1.0, or 2.0 points); 4. hachinski ischemic scale (his) ≤ 4 points; 5. hamilton depression rating scale (hamd) \< 20 points; 6. without severe bone and joint diseases and able to walk independently; 7. able to conduct vision and hearing tests; 8. volunteering to participate in this trial and signing an informed consent form. exclusion criteria the exclusion criteria are as follows: 1. dementia caused by other systemic or neurological diseases, such as central nervous system infections, post-traumatic dementia, parkinson's disease dementia; 2. suffering from acute illness, upper limb extrapyramidal stiffness, neurological or psychiatric disorders (except cognitive impairment); 3. with medical history that interferes with cognitive function assessment, such as past history of psychiatric drug abuse, drug addiction within the past 5 years, and alcohol abuse; 4. afraid of acupuncture and cannot accept acupuncture treatment; 5. currently participating in other clinical trial that affects the outcome evaluation of this trial.
three instructional interventions for prehospital cervical spinal immobilization by laypeople

Conditions: Cervical Vertebra Injury; Cervical Vertebra Fracture

Summary: it is not known if bystanders equipped with point-of-care (poc) instruction are as effective as bystanders with in-person training for c-spine immobilization. therefore, poc instructional interventions were developed during this study in response to the scalability challenges associated with in-person training to measure the comparative effectiveness and skill retention of poc instructions vs in-person training using a randomized clinical trial design.

road traffic injuries (rtis) are the largest contributor to the global injury burden, which disproportionately affects low- and middle-income countries (lmics). traumatic spinal cord injury (tsci) is the highest contributor to years lived disabled (ylds) resulting from rtis, accounting for 74.8% of ylds from rti. with a lack of robust emergency medical services (ems), there has been increasing reliance on layperson bystanders to respond to rtis in lmics. early spinal immobilization has the potential to limit neurological deficits secondary to tsci and morbidity. bystanders may be trained in-person or point-of-care (poc) instruction may be provided, as exists with automated external defibrillators and tourniquets. however, it is unknown if bystanders equipped with poc instruction are as effective as bystanders with in-person training for c-spine immobilization. therefore, poc instructional interventions were developed in response to the scalability challenges associated with in-person training to measure the comparative effectiveness and skill retention of poc instructions vs in-person training using a randomized clinical trial design. the poc instructional flashcard was first piloted with an initial cohort of participants who were not assigned to any longitudinal follow-up date to pilot poc instructional interventions for c-spine immobilization and receive feedback for instructional flashcard revision prior to launching the "trial." data from these participants is not considered part of the "trial" for analytic purposes. this entire testing process is with participants who are healthy volunteers and researchers simulating spinal injury victims to test which method of instruction is most effective and durable for understanding.

Eligibility criteria:
inclusion criteria: * understand spoken and written english. exclusion criteria: * none
neurofunctional and neurochemical markers of treatment response in bipolar disorder

Conditions: Bipolar I Disorder

Summary: the purpose of the research is to study brain structure, function and chemistry of patients with bipolar disorder who are receiving lithium, an fda-approved treatment for bipolar mania, in order to better understand who benefits from treatment and why they respond to medications. studying this may help improve treatment and outcome in patients with bipolar disorder.


Eligibility criteria:
inclusion criteria- bipolar patients (manic=, depressed=60; 30 patients/year): 1. the patient meets dsm-iv criteria for type i bipolar disorder, manic or mixed, or depressed. 2. the patient has an index young mania rating scale (ymrs)total score \>15 or montgomery asberg rating scale (madrs) total score \>20. 3. the patient is between 15 and 55 years old. inclusion criteria- healthy subjects (n=40): 1. healthy subjects will be between the ages of 15 and 55 years. 2. healthy subjects will have no history of any axis i psychiatric disorder. 3. healthy subjects will have no first-degree relatives with affective or psychotic disorders. exclusion criteria: all subjects will be excluded from participation for the following reasons. 1. any medical or neurological disorder that could influence fmri and mrs results. 2. a history of mental retardation or an estimated iq total score \<85. 3. an mri scan is contraindicated in the subject for any reason, including psychological impediments to being inside the mr scanner. 4. the patient cannot attend follow-up visits.
effects of exenatide on hypothalamic obesity

Conditions: Hypothalamic Obesity

Summary: the primary aim of this study is to evaluate the effect of exenatide on weight status (change in body mass index) of children treated for craniopharyngioma that have developed hypothalamic obesity at children's hospitals and clinics of minnesota. we hypothesize that exenatide given to hypothalamic obese children for 6 months will reduce their body mass index significantly from baseline.

hypothalamic obesity is when individuals suffer from acute weight gain after brain tumor treatment, involving secondary damage to the ventromedial nucleus of the hypothalamus, which may lead to obesity. the weight gain is uncontrolled and not receptive to diet and exercise interventions. the rate of long-term obesity in children diagnosed with craniopharyngioma can be as high as 50%. exenatide, a drug indicated for diabetes, is an incretin mimicking agent that mimics the enhancement of glucose-dependent insulin secretion and several other antihyperglycemic actions of incretins has resulted in weight loss when given to diabetics. exenatide shows potential to benefit patients suffering from hypothalamic obesity by slowing gastric emptying and therefore reducing food intake. also increasing the glucagon-like peptide 1 (glp-1) circulation, decreased due to obesity, at the already compromised glp-1 receptor site of the hypothalamus could potentially help with regulation of appetite.

Eligibility criteria:
inclusion criteria: * \>/=6 months post surgical or radiation or chemotherapy treatment for 1° craniopharyngiomas or other suprasellar tumors * 10-21 years old * age-and sex-adjusted bmi \>/=95% * parent sign consent and patient sign assent exclusion criteria: * \< 6 months post surgical or radiation or chemotherapy treatment for 1° craniopharyngiomas or other suprasellar tumors * pregnant or breastfeeding, or those women who plan to get pregnant * renal impairment * gastroparesis * pancreatitis * diabetes * \<1 month post initiation of metformin treatment * prescription or over-the-counter weight loss medications within 3 months of screening * are actively participating in, or have participated in a formal weight loss program within the last 3 months * have had bariatric surgery

Keywords: hypothalamic obesity exenatide byetta craniopharyngioma
effects of neuromobilization on median nerve elasticity

Conditions: Median Nerve Disease

Summary: purpose: the aim of this study was to investigate the effect of median nerve neuromobilization on median nerve elasticity using shear wave elastography. methods: the study included 36 healthy volunteers (72 upper extremities) aged 18-30 years. inclusion criteria; no known systemic neuromuscular and metabolic diseases, no nerve impingement syndrome, and no upper extremity bone-tendon-muscle surgery in the last six months. sociodemographic data of the participants were recorded. wrist flexion and extension bilaterally with universal goniometer and finger grip strength bilaterally were measured with pinchmeter. median nerve stress test was performed. median nerve elasticity was measured by shear wave ultrasound elastography. the extremity of the dominant side as a study group and the non-dominant side as a control group were measured bilaterally. median nerve neuromobilization (stretching (n = 18) and shifting (n = 18)) was applied to the upper extremities of the dominant side. the application was carried out as 3 sets in one session. evaluations were repeated after application.


Eligibility criteria:
inclusion criteria: * 18-30 years of age * healthy individuals without any known systemic disease exclusion criteria: * those who have undergone an upper extremity bone-tendon-muscle operation in the last six months * people with a systemic disease such as rheumatoid arthritis, diabetes mellitus * patients with any neuromuscular disease

Keywords: neuromobilization elasticity shear wave elastography
effects of exercise on srage levels and cardiometabolic risk factors

Conditions: Type 2 Diabetes

Summary: the purpose of this study is to examine the effects of exercise on diverse cardiometabolic risk factors and indicators of atherosclerosis in patients with type 2 diabetes mellitus (t2dm).


Eligibility criteria:
inclusion criteria: * type 2 diabetes * stable body weight * sedentary lifestyle exclusion criteria: * smoked cigarettes * cardiovascular disease * chronic kidney * chronic liver disease * pregnant or breastfeeding * any other major illness
diagnosis and follow-up of patients with subclinical hypothyroidism

Conditions: Congenital Hypothyroidism; L-Thyroxine; Follow-Up

Summary: long term follow-up of the patients with delayed tsh elevation or subclinical hypothyroidism has been seldom reported. the purpose of this study was to explore the diagnostic criteria for subclinical hypothyroidism and the initial dosage of l-thyroxine through long-term follow up for infants with subclinical hypothyroidism ，and evaluate the curative effect.

long term follow-up of the patients with delayed tsh elevation or subclinical hypothyroidism has been seldom reported. the purpose of this study was to explore the diagnostic criteria for subclinical hypothyroidism and the initial dosage of l-thyroxine through long-term follow up for infants with hyperthyrotropinemia，and evaluate the curative effect.all live-born neonates in province took part in the screening program from october, 1999 to september ,2006. laboratory tests are performed as a time resolved fluoro-immunoassay (trfia). tsh is measured with a cut-off \> 9 mu/l. the diagnostic standard for subclinical hypothyroidism was: tsh ≥ 20 mu/l, t3 and t4 normal or low-normal ,or tsh \> 5.6 mu/l and \< 20 mu/l on initial determination and on follow-up or tsh levels increase on follow-up and/or gradually declining t4 levels.l-thyroxine was administered for substitution therapy. after 2 years therapy，allround evaluation was performed. compare the correlation to effects with different level of tsh、starting time of therapy and environment. compare the effects between subclinical、temporary and permanent hypothyroidism.

Eligibility criteria:
inclusion criteria: * the diagnostic standard for manifest hypothyroidism and subclinical hypothyroidism was defined as follows: * hypothyroidism - tsh \> 40 mu/l and t3 and t4 below the reference range or tsh \> 40 mu/l, t3 normal and t4 below the reference range \[2\] * subclinical hypothyroidism - tsh ≥ 20 mu/l, t3 and t4 normal or low-normal or tsh \> 5.6 mu/l and \< 20 mu/l on initial determination and on follow-up or tsh levels increase on follow-up and/or gradually declining t4 levels.

Keywords: congenital hypothyroidism diagnosis l-thyroxine newborn screening
mechanisms and treatment of intradialytic hypertension

Conditions: Intradialytic Hypertension

Summary: 1. to determine in a cross sectional case-controlled cohort study of 50 hemodialysis patients if blood pressure elevations with hemodialysis are associated with decreased endothelial cell function (measured by brachial artery flow mediated dilation and endothelial progenitor cell number), both of which are novel mechanistic markers in the causal pathway for detrimental cardiovascular outcomes; and 2. to determine if lowering blood pressure with carvedilol in 25 esrd subjects with blood pressure elevations with hemodialysis can improve endothelial cell dysfunction as a surrogate mechanistic marker for improving cardiovascular outcomes.


Eligibility criteria:
inclusion criteria: * on hemodialysis \> 30 days * aged 18 to 80 years old * ability to provide informed consent * primary nephrologist deems patient is at target dry weight * predialysis sbp \>140 or postdialysis sbp\>130 exclusion criteria: * patients with active wounds * blood pressure unable to be measured by routine mechanisms in the upper extremity * change in blood pressure medications in the previous 2 weeks * intolerance of beta or alpha-blockers * pregnancy * resting heart rate \<50 * life expectancy \< 6 months * current therapy with carvedilol or contraindication to carvedilol (only in the intervention arm)

Keywords: hypertension hemodialysis